Preprinted Form 1095-B
Full page with preprinted instructions on back.
Use this preprinted laser form for printing form 1095-B. Folding perforation at 5 ½”. Order by number of sheets needed.
95DWENV05 - Moisture Seal
95DWENVS05 - Self Seal
1964 - Larger, for inserters
A 1095-B form must be issued by a self-insured employer with less than 50 full-time employees (including full-time equivalent employees), or by the insurer to employees and to the IRS as proof of healthcare coverage.
To order a free sample, please contact us at 1-800-968-1099, or firstname.lastname@example.org.
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